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Ashley O'Neill was rushed to hospital two hours before she expected her first pregnancy, in the middle of a dangerous spring storm – with fear in her heart and amniotic fluid pouring down her leg.
At 21 weeks pregnant, O'Neill had abnormal vaginal bleeding. With increasing stress, She and her husband, George, visited the community hospital in rural Maryland where they were cared for during her pregnancy.
After arriving at a local hospital, O'Neill asked to be evaluated by an ob/gyn.
“They just took me away,” she said. “I was there for hours before the doctor came to see me. And all this time my husband said, 'Where's the ultrasound? She needs an ultrasound! what's going on?' ”
Finally, a doctor entered the room where O'Neill was waiting and began to perform a vaginal examination. That's when she saw the doctor's jaw drop.
O'Neill The amniotic sac, the fluid-filled structure that surrounds a developing fetus, is exposed. When a person goes into labor, the sac often tears, also known as water breaking. But with O'Neill's pouch exposed, she's vulnerable to complications, including premature rupture and possibly preterm labor.
The small community hospital did not have the resources to support preterm births.
And so began the two-hour drive. O'Neill was airlifted to a major hospital, where she said the weather was so stormy that she couldn't get outside.
O'Neill's experience is just one example of the challenges many mothers and babies face living in what are considered “maternity deserts” in America, where many mothers and babies lack access to robust maternity services.
When O'Neill arrived at the big hospital, her son, Vinson, was born prematurely at 21 weeks.
“He was born with a beating heart of 15 ounces. I like to say he died in my arms, but I don't think he made them there,” O'Neill said.
She and her husband were baptized in the hospital after the death of Vinson.
Then, less than six hours after giving birth, O'Neil was wheeled through the labor and delivery room to go home.
On the way to the exit, she hears the screams of the other children in the room.
Preterm birth a The leading cause of infant mortality In the United States.
In the year In 2023, six out of every 1,000 children born will die Provisional information was released Thursday by the US Centers for Disease Control and Prevention. The data shows that last year's infant mortality rate – 5.6 per 1,000 live births – has not changed from the rate in 2022.
The preterm birth rate – where babies are born before 37 weeks of pregnancy – remained at a record high of 10.4% last year, unchanged from 2022, according to the March of Dimes, an infant and maternal health nonprofit.
“That means more than 370,000 babies — that's 1 in 10 babies — will be born too early,” said Dr. Amanda Williams, interim medical director of the March of Dimes. Racial differences persist, she added; The preterm birth rate for blacks is 1.5 times higher than for other children.
The March of Dimes gave the United States a high preterm birth rate of D+ in its annual “report card” on U.S. maternal and infant health released Thursday, marking the third year in a row that the country has earned that grade.
Among the 100 US cities with the highest birth rates, one-third were given an F grade in the report for their highest birth rates last year.
Detroit had the highest rate with 15.6% of very early births, followed by Cleveland at 14.8% and Mobile, Alabama at 14.6%, the report said.
Most states with high preterm birth rates are maternal care deserts, Williams said.
“If people can't get care, they don't have enough prenatal care,” she said. “Things like inadequate prenatal care are a major cause of preterm birth.”
To improve access to care, the March of Dimes supports Medicaid expansion, a key component of the Affordable Care Act. Associated with a low maternal mortality rate.
“We know that prenatal care often comes through Medicaid, and if there's not a good Medicaid policy in certain areas, that's a driver” of birth rates, she said.
U.S. cities with high preterm birth rates are “areas with a lot of chronic disease and patients with high blood pressure, diabetes, obesity — all of these are drivers of preterm birth,” Williams said.
The cities with the lowest birth rates in the report were Ramapo, New York, at 5.2% and Irvine, California, at 7% – both rated A – followed by Gilbert, Arizona, at 7.8%, which received an A-. Level
Lori Tremmel Freeman, CEO of the National Association of County and City Health Officials, which was not involved in the March of Dimes report, said the continued prevalence of premature births in the United States is “outrageous.”
“It's tragic that as a developed country we have these very poor outcomes around maternal morbidity and mortality, infant mortality and morbidity, and that the disparity between white and black and brown populations continues and widens. “We're not making any headway on this, and we need some really targeted preventative measures and other services to address this problem,” Freeman said.
“This is a complex issue, because it involves not only the new mother during her pregnancy, but also making sure that she comes into the pregnancy healthy.” “They often don't have suppliers in rural and economically disadvantaged areas. Access to health care is difficult. Access to prenatal care is difficult for working mothers. So there are a lot of contributing factors here, and the whole health system — including public health and health care — is really going to turn a corner and reverse some of these effects.
To improve maternal and infant health and reduce preterm birth rates, the March of Dimes called for more states to provide 12 weeks of paid family leave, require Medicaid to pay for doula care, and create committees to review and study maternal and infant outcomes. Death and expanding access to midwives, among other actions.
“We know that when low-risk pregnancies are supported by a midwife, they are associated with lower risks of preterm birth,” Williams said.
some Research suggests Midwifery care can reduce two-thirds of maternal and infant deaths and significantly Reduce the risk of serious complications associated with pregnancy or childbirth, says Amanda Shafton, national midwifery director of the Ob Hospitalist Group.
“in the united statesThere are only 4 midwives per 1,000 live births, while other high-income countries have 30-70 midwives per 1,000 live births. Countries with the lowest maternal mortality rates prioritize midwife-based care, and most babies are delivered by midwives,” Shafton, who was not involved in the March of Dimes report, wrote in an email.
“Changes across the board are needed to actively engage nurse-midwives in midwifery in the United States,” she said. “It is important to encourage changes in hospital regulations, increased opportunities for collaboration between midwives and OB-GYNs, and improved regulations at the state and federal levels to allow nurse-midwives to practice their full education and licensure.”
For midwives, Shafton added, it is important to “increase the midwifery workforce” and “find equitable payment models” from public and private insurance, as well as individual wages.
The March of Dimes recommends that pregnant women discuss low-dose aspirin with their providers to reduce the risk of preterm birth, especially if they are at risk for the condition. Preeclampsia
“It's absolutely my favorite and most impactful intervention, because it's so simple. You can buy 81 milligrams of low-dose aspirin over-the-counter at your local pharmacy and take prenatal vitamins daily from around 12 weeks through the end of pregnancy to reduce preeclampsia and preterm birth in at-risk patients. Preeclampsia,” Williams said.
We encourage all patients to be educated about it. All prenatal care providers are screened. And if the patient is at risk, and many patients are, they take it every day from approximately 12 weeks until the end of pregnancy,” she said. “There are many different risk factors that need to be discussed with one's prenatal care provider.”
These risk factors include being older than 35, using in vitro fertilization, being black due to exposure to systemic racism, having a low income, trying your first pregnancy, having twins or triplets, or having a pre-existing chronic medical condition. High blood pressure.
Telehealth can be a way to help pregnant women, O'Neill said.
“Every pregnant woman living in a maternal health care desert should have access to a health care app monitored by remote providers. In this app, she can monitor how she feels and if she has any symptoms such as swelling or headache. She can ask questions,” she said.
“I think they should also go home with a blood pressure monitor,” she says, especially if they are at increased risk for early preeclampsia. “So you can enter the vitals every day, and the system can alert providers when the readings are out of normal parameters. Also, the use of mobile health vans for antenatal visits is critical to increase access.”
O'Neill said she sees it as a call to action to raise awareness of preterm birth and expand solutions needed to reduce risks.
In May 2016, O'Neill became pregnant with her second child, Colin, shortly after Vinson gave birth prematurely. In the year In April 2019, Colleen was born at the same small community hospital where O'Neill was seen during her previous pregnancy.
In her second pregnancy, the hospital wanted to transfer her again to the bigger hospital – but it was too late. “Labor came so quickly,” O'Neill said.
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